Below-knee bypass for limb salvage. Comparison of autogenous saphenous vein, polytetrafluoroethylene, and composite dacron-autogenous vein grafts
R. W. Hobson 2nd, J. A. O'Donnell, Z. Jamil and K. Mehta
Autogenous saphenous vein was used preferentially for 92 below-knee bypass
procedures (44 femoral-distal popliteal and 48 femoral-distal tibial or
peroneal) performed for limb salvage in 87 adult male patients during a
30-month period of study. When a saphenous vein was unavailable or of
unsuitable length or diameter, we randomly used expanded
polytetrafluoroethylene (PTFE) and composite Dacron-autogenous vein (DV)
grafts. With good run-off, all grafts have remained patent. However, with
poor run-off, cumulative patency by the life table method decreased to 54%
for autogenous saphenous vein and 45% for PTFE, which was not significantly
different. All composite DV grafts used with poor run-off became occluded
within the first ten months of the study. We continue to recommend use of
autogenous saphenous vein for revascularization of the ischemic lower
extremity. When a suitable saphenous vein is unavailable, PTFE is a
satisfactory alternative graft that is superior to composite DV grafts.
